ISOLATED PROLAPSE OF THE POSTERIOR MITRAL LEAFLET - RESULTS OF RECONSTRUCTIVE SURGERY

Out of 522 patients undergoing mitral valve reconstruction for mitral regurgitation between 1988 and June 1994, the authors studied 159 case s of isolated mitral regurgitation by prolapse of the posterior mitral leaflet. There were 98 men (62%) and 61 women (38%), with an average age of 58.4 +/- 10.4 years. The functional class and ejection fraction were 2.8 +/- 0.11 and 0.66 +/- 0.2 respectively. In 155 patients, sur gery consisted in quadrangular resection of the prolapsed tissue, foll owed in 83 cases by sliding posterior valvuloplasty and in 72 cases by plicature of the annulus. In 4 cases, the prolapse was treated by imp lantation of artificial chordae tendinae. A Carpentier-Edwards ring wa s inserted in all cases. There were no hospital deaths. Echocardiograp hy was performed before discharge from hospital and showed satisfactor y mitral valve function in 98% of cases : slight systolic anterior mot ion (SAM) was observed in one case. All patients were followed up for an average of 3.67 +/- 0.10 years. At six years, survival was 93 +/- 7 %; moreover, 93 +/- 7% and 97 +/- 3% of patients had no thromboembolic or haemorrhagic complications. Six patients were reoperated, three of them in the first year of follow-up. At six years, 95 +/- 5% of patie nts were free of reoperation and 81 +/- 11% were free of all complicat ions. The authors conclude that the excellent medium term survival and the low rate of complications are evidence in favour of conservative surgery for treatment of mitral regurgitation due to prolapse of the p osterior mitral leaflet.